Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
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22<br />
<strong>Health</strong> systems in transition <strong>Canada</strong><br />
Fig. 2.1<br />
<strong>Organization</strong> of the health system in <strong>Canada</strong><br />
Provincial and territorial governments<br />
<strong>Regional</strong> health<br />
authorities<br />
Mental health<br />
and<br />
public health<br />
providers<br />
Canadian Agency<br />
<strong>for</strong> Drugs and<br />
Technologies in <strong>Health</strong><br />
(1989)<br />
Home care<br />
and<br />
long-term<br />
providers<br />
Ministers and<br />
Ministries or<br />
Departments of <strong>Health</strong><br />
Provincial and territorial<br />
prescription drug programmes<br />
Hospital<br />
and<br />
medical services<br />
providers<br />
Canadian Institute<br />
<strong>for</strong> <strong>Health</strong><br />
In<strong>for</strong>mation<br />
(1994)<br />
<strong>Health</strong> Council<br />
of <strong>Canada</strong><br />
(2003)<br />
Canadian Constitution<br />
Transfer payments<br />
F/P/T Conferences<br />
of Ministers and<br />
Deputy Ministers of<br />
<strong>Health</strong> and Committees<br />
<strong>Canada</strong> <strong>Health</strong><br />
Act, 1984<br />
Federal government<br />
Miinister of <strong>Health</strong><br />
<strong>Canada</strong> <strong>Health</strong><br />
Infoway<br />
(2001)<br />
<strong>Health</strong> <strong>Canada</strong><br />
Public <strong>Health</strong><br />
Agency of <strong>Canada</strong><br />
Canadian<br />
Blood Services<br />
(1996)<br />
Statistics <strong>Canada</strong><br />
Canadian Institutes<br />
<strong>for</strong> <strong>Health</strong> Research<br />
Patented<br />
Medicine Prices<br />
Review Board<br />
Canadian<br />
Patient Safety<br />
Institute<br />
(2003)<br />
Note: Solid lines represent direct relationships of accountability while dotted lines indicate more indirect or arm’s length relationships.<br />
<strong>Canada</strong> is a constitutional federation with sovereignty, authorities and<br />
responsibilities divided between the federal government and the provincial<br />
governments. With the exception of jurisdiction over hospitals and psychiatric<br />
institutions, which the constitution assigns exclusively to the provinces, the<br />
authority over health or medical care was never explicitly addressed in the<br />
original document, which, in the 1860s, assigned powers to the central and<br />
provincial governments. As a consequence, authority can only be inferred<br />
from a number of other provisions in the constitution. Subsequent judicial<br />
decisions support the view that the provinces have primary, but not exclusive,<br />
jurisdiction over health care (Braën, 2004; Leeson, 2004). Although the three<br />
northern territories have a constitutional status that is subsidiary to the federal<br />
government, they have been delegated primary responsibility <strong>for</strong> administering<br />
public health care by the federal government.<br />
While the funding, administration and delivery of public health care in<br />
<strong>Canada</strong> are highly decentralized (Axelsson, Marchildon & Repullo-Labrador,<br />
2007), the federal government retains important “steering” responsibilities<br />
in terms of key dimensions of medicare through the <strong>Canada</strong> <strong>Health</strong> Act, the